Assessment and mapping of the waste management infrastructure for the management of Pharmaceuticals Inutilisables (PPI) in Côte d'Ivoire

This stock represents about 97% of the total PPI existing in the country, limiting the current capacity of healthcare structures to manage new PPI flows. The NPSP stock is estimated to be 75% of the total PPI stock in the country, representing around 1300 tonnes, with a total destruction cost of $2.3 million (1.8$/kg). The annual PPI generation flow represents only 3% of the total existing PPI, amounting to around 50 tonnes, with an estimated total destruction cost of $90,000 per year (1.8$/kg). The PPI generated at the NPSP represents about 0.5% of its pharmaceutical stock volume per year and 2% of its pharmaceutical stock value per year, equivalent to around 50 to 2500 billion CFA francs. Free products from programs and targeted free products represent nearly 80% of the annual PPI volume flow. The products related to HIV are 5 times more likely to become PPI and represent around 70% of the value of PPI generated per year at the NPSP, mainly due to their short lifespan. However, they do not represent alarming quantities of stock PPI, mainly due to the total destruction campaigns of ARV organized in 2010 (100 tonnes), 2013 (100 tonnes), and 2016 (67 tonnes). The top 3 HIV products generating the most significant PPI losses in value are diagnostic HIV tests, while the top 3 HIV products generating the most PPI volume are reagents and CD4. The regions of Tonkpi and Abidjan 2 concentrate more than half of the stock in volume. The "false medicines," considered PPI, will create an additional stock of around 300 tonnes and a mean annual destruction flow of 50 tonnes. The main causes of PPI generation are the lack of governance and the absence of dedicated financing, with ad-hoc destruction campaigns organized by partners or NGOs supervised by the DPML. The current PPI management process does not respect the procedures defined by the authorities and indicates a lack of clear governance and financing. Only around 540 tonnes of PPI stock have been officially destroyed since 2010 at the level of healthcare structures and the NPSP, as part of 6 punctual initiatives carried out by partners or NGOs, mainly targeting HIV products (ARV, IO, and laboratory reagents). Two major obstacles hinder PPI management: the absence of an organized collection system linked to a low level of governance and the absence of allocated funding, leading to a saturation of storage capacity with stocks of old PPI limiting the handling of new flows. The solutions integrated into PPI management and reverse logistics of PP aim to address four major problems: how to organize the destruction of the accumulated PPI stock over the past 20 years, notably at the NPSP; what routine PPI management system to put in place; what reverse logistics system for PP to put in place, particularly to anticipate peremptory; and how to prevent PPI generation. The dimensions of the design of integrated PPI management solutions cover the operational model, governance, and financing.